Healthcare Provider Details

I. General information

NPI: 1053470005
Provider Name (Legal Business Name): SANJAY PAREKH DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JAY PAREKH DDS MS

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 11/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1937 CENTRAL AVE
ASHLAND KY
41101-7747
US

IV. Provider business mailing address

5526 WINDING CAPE WAY
MASON OH
45040-5017
US

V. Phone/Fax

Practice location:
  • Phone: 606-329-0038
  • Fax:
Mailing address:
  • Phone: 513-335-2342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number30.022056
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8434
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: